老年代谢紊乱集簇与认知功能障碍相关性研究  

Relationship between cognitive function and clustering of metabolic disorders in the elderly population

作　　者：董凌燕[1] 张洁 王月菊[1] 邰胜[1] 唐海英[1] 郭健政[1] 李建中[1] 

机构地区：[1]苏州大学附属第一医院老年科,苏州215006 [2]山东省威海市文登区人民医院医务科,威海264400

出　　处：《中国实用内科杂志》2014年第11期1095-1098,共4页Chinese Journal of Practical Internal Medicine

基　　金：血管内皮祖细胞治疗老年动脉粥样硬化的临床基础研究(H201210)

摘　　要：目的探讨老年人代谢紊乱集簇与认知功能障碍的相关性。方法选择2006年12月至2013年12月在苏州大学附属第一医院老年科就诊的患者160例,记录入选对象的性别、年龄、文化程度等,检测身高、体重、血压、血脂、血糖、胰岛素等指标,采用稳态模型评价胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(ISI),根据蒙特利尔认知评估量表(Mo CA)评定认知功能。根据代谢综合征诊断标准将全部研究对象分为对照组(无代谢紊乱组)、1种代谢紊乱组(M1)、2种代谢紊乱组(M2)、3种或以上代谢紊乱组(M3)。各代谢紊乱组分别进行认知功能评定及相关性分析。结果随着代谢紊乱组分数目增加,体重指数(BMI)、收缩压(SBP)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、HOMA-IR逐渐升高,ISI及Mo CA评分逐渐下降。Mo CA各分项评分比较,各组视空间与执行功能、抽象概括、记忆评分逐渐下降,注意、语言及定向力在M3组才开始明显下降,而命名评分在各组差异无统计学意义。Spearman相关分析显示,FPG、SBP、BMI、TG、TC、HOMA-IR与Mo CA评分呈显著负相关(P<0.01),ISI与MoCA评分呈正相关。多元逐步回归分析显示,HOMA-IR、FPG、SBP、TG是影响老年代谢紊乱者Mo CA评分的独立危险凶素。结论老年人认知功能损害与代谢紊乱集簇显著相关,且其认知损害具有一定的选择特异性,血脂异常、高血糖、高血压和胰岛素抵抗是该年龄段人群认知功能损害的主要危险因素。Objective To analyze the relationship between cognitive function and clustering of metabolic disorders in the elderly population. Methods A total of 160 subjects were included and the data such as gender,age,education,height,weight,blood pressure（ BP）,serum lipid profiles,plasma glucose（ PG） and fasting insulin（ FINS） were collected. All the subjects were divided into 4 groups according the diagnostic standard for metabolic syndrome： control group（ no disorders）,1 disorder group（ M1）,2 disorder group（ M2） and ≥3 disorder group（ M3）. Homeostasis model assessment of insulin resistance（ HOMA-IR） was used to evaluate insulin resistance,and insulin sensitivity index（ ISI） was used to evaluate insulin sensitivity. Results The levels of body mass index（ BMI）,fasting plasma glucose（ FPG）,systolic blood pressure（ SBP）,total cholesterol（ TC）,triglycerides（ TG） and HOMA-IR were significantly increased while ISI and Mo CA score were decreased as the increased quantity of metabolic disorders. As comparing the scores of sub-items,we found visuospatial and executive function,abstraction,and memory score were gradually decreased in all groups,while attention,language and orientation were significantly decreased just in the M3 group. Naming scores had no significant differences between groups.Spearman correlation analysis showed that the FPG,SBP,BMI,TG,TC and HOMA-IR were negatively correlated with Mo CA scores,while ISI was positively correlated with Mo CA score. Stepwise regression analysis showed that HOMA-IR,FPG,SBP and TG were dependent risk factors of Mo CA scores. Conclusion Cognitive impairment is significantly related to clustering of metabolic disorders,and also has selecting specificity. Dyslipidemia,hyperglycemia,hypertension and insulin resistance may be important contributors of cognitive impairment in the elderly population.

关 键 词：代谢综合征 胰岛素 认知功能 

分 类 号：R58[医药卫生—内分泌]